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Netzwerk Essstφrungen 2007 - First Announcement! The next meeting of the Netzwerk Essstφrungen conference takes place from October 18-20, 2007 in the Alpbach, Tyrol, Austria. This is the 15th international conference to be held there and all sessions are open to sufferers, carers/relatives and clinicians/researchers. To receive information about the conference you can log on to www.netzwerk-essstoerungen.at or contact the organisers by e-mail on info@newzwerk-essstoerungen.at
Skipping insulin for weight risky
Like many teenage girls, Lee Ann Thill was obsessed with her appearance. A diabetic, she was already suffering from bulimia -- forcing herself to throw up to lose weight. But it wasn't enough, and she'd recently put on 20 pounds. Then one day at a camp for diabetic teens, she heard counselors chew out two girls for practicing "diabulimia" -- not taking their insulin so they could lose weight, one of the consequences of uncontrolled diabetes. Don't you realize you could die if you skip your insulin? the counselor scolded. Don't you know you could fall into a coma or damage your kidneys or your eyes? But that's not what registered with Thill, who has Type 1, or juvenile diabetes. Instead, she focused on this: Skipping insulin equals weight loss. For the next 17 years, diabulimia was her compulsion. "I took just enough insulin to function," said Thill, now 34, of Magnolia, N.J. Today, she worries about the long-term damage that may have come from her weight obsession. At 25, a blood vessel hemorrhage in her eye required surgery. At 28, doctors told her she had damaged kidneys. "I'm fearful for the future," Thill said. "I feel very strongly that had I taken care of myself, I could have lived as long as anyone without diabetes. I don't think that's going to happen now." Diabulimia is usually practiced by teenage girls and young women, and it may be growing more common as the secret is exchanged on Internet bulletin boards for diabetics and those with eating disorders. One expert who has studied the phenomenon estimates that 450,000 Type 1 diabetic women in the United States -- one-third of the total -- have skipped or shortchanged their insulin to lose weight and are risking a coma and an early death. "People who do this behavior wind up with severe diabetic complications much earlier," said Ann Goebel-Fabbri, a clinical psychologist at the Joslin Diabetes Center in Boston. The American Diabetes Association has long known about insulin omission as a tactic to lose weight. But "diabulimia" is a term that has only cropped up in recent years and is not a recognized medical condition, said Barbara Anderson, a pediatrics professor at Baylor College of Medicine in Houston. Type 1 diabetes is a disorder in which the body's own immune system attacks insulin-producing cells in the pancreas. People with this disease produce little or no insulin, so they take shots of the hormone daily. It differs from Type 2, the form associated with obesity and which accounts for about 90 to 95 percent of all diabetes. Insulin is vital for delivering glucose from the bloodstream to the body's cells. Without insulin, cells starve even while the bloodstream becomes burdened with too much glucose. When Type 1 diabetics skip or reduce their insulin, they risk falling into a coma or even dying. Blindness, amputations and kidney failure are some of the long-term complications that can develop. Warning signs for diabulimia include a change in eating habits -- typically someone who eats more but still loses weight -- low energy and high blood-sugar levels, Goebel-Fabbri said. Frequent urination is another signal. When sugars are high, the kidneys work overtime to filter the excess glucose from the blood. This purging of sugar from the body through the kidneys is similar to someone with bulimia, who binges and then purges, or vomits, Anderson said. Studies show that women with Type 1 diabetes are twice as likely to develop an eating disorder. Ironically, good diabetes management, which requires a preoccupation with food, counting carbohydrates and following a diet, may lead some to form an unhealthy association with food, Goebel-Fabbri said. Jacq Allan, 26, of London, is a diabulimic. When recently interviewed, she said she had not taken her insulin shots for two weeks and rarely takes them regularly. She weighs 42 pounds less than she did a year ago. Allan is stuck between two fears: taking insulin, which may lead to weight gain, and the damage her destructive compulsion is doing to her body. "I'm terrified of insulin," Allan said. "Every morning I wake up and think maybe I should go to the hospital." Diagnosed with Type 1 diabetes nearly three years ago, Allan said she can feel the constant, sky-high sugar in her blood. Her list of ailments -- chest pain, heart palpitations, muscle cramps, bacterial infections and lower back pain -- are not the usual health problems of a twenty-something. "I'm constantly worried that my eyes are going to go, but they seem relatively OK for the moment," she said. "I always wonder if this will be the day that some major organ fails. I kind of want something to happen because then maybe I'll stop." Gwen Malnassy, 21, of Santa Monica, Calif., detailed her struggle with diabulimia for three years in a diary she posted on the Internet. "If you don't think it will happen to you, don't fool yourself," writes Malnassy, diagnosed with diabetes at 9, in her final entry 11 months ago. "I believed the same." Doctors diagnosed Malnassy with both anorexia and bulimia at 13, she said. "I would look at magazines and think that if I looked like the models, I would have more friends and be more popular," Malnassy said in a recent interview. She began withholding insulin at 17 after learning of the practice during a doctor's visit and continued withholding insulin off and on until last year. Malnassy continues in her online diary: "I will say it again. Reach out; get help. Do not fall; do not let the disorder consume you. It's a miserable way to exist." ΰ http://care.diabetesjournals.org/cgi/content/abstract/22/12/1956 Walter Vamdereycken
C THE NETHERLANDS C In the Netherlands since 2004 the Dutch Academy for Eating Disorders (NAE) exists. It is a multi-disciplinary association. It now has more than 100 members and is still growing. Professionals working with eating disorders and institutions specialized in the treatment of eating disorders can become member of the association. The aim of the NAE is to improve structure and quality of care for patients with eating disorders and to promote research and prevention. The NAE has special interest groups on Nutrition, Parent Child Interaction and Chronic Eating Disorders. The NAE strongly cooperates with the patient organization. The NAE has a website which formerly belonged to the Knowledge Center for Eating Disorders. This site is made possible by contributions of mental health organizations. The website of the NAE is at: www.naeweb.nl Hans Bloks, Ph D; President NAE ννννννννννννννννννννννννν C GERMANY C New German association for eating disorders In March 2006 a new professional organisation was founded in Germany: Deutsche Gesellschaft fuer Essstoerungen (DGESS) with on the board of directors: Manfred Fichter, Beate Herpertz-Dahlmann, Brunna Tuschen-Caffier, Stephan Zipfel and Martina de Zwaan. See the website: www.dgess.de Walter Vandereycken ννννννννννννννννννννννννν C DEBATE/DISCUSSION C Walter Wandereycken has started an interesting debate/discussion with some quite passionate reactions from various quarters. See what you think and feel free to contact Walter (walter.vandereycken@ppw.kuleuven.be) with your thoughts or feelings on the topic below!! MANDOMETER ‘the only effective treatment for anorexia nervosa’ ?? There were on the email list group of the Academy for Eating Disorders (AED) some questions about the so-called “mandometer treatment” for eating disorders. I gave my opinion and received some replies. I thought it worthwhile for colleagues to read it. ----------------------------------------------- AED List Forum Wednesday, November 29, 2006 Once therapists start to apply a commercial patent ("registered mark") on their approach, I immediately become sceptical. Usually the approach is governed more by economic than scientific rules. And so does the marketing. The mandometer treatment is a typical example. In the recent issue of the European Eating Disorders Review the mandometer-group of Bergh et al. seriously question the data on effectiveness of family therapy in eating disorders (with a firm and thought-provoking reply from Daniel le Grange); although the discussion is interesting, quite typical for the "marketing strategies" of this group, they (ab)use the forum for advertising their mandometer treatment which they sell as the "credible alternative", while in reality the available evidence is weak. The core attraction ("original ingredient" well marketed) is a computerized way of feedback of which it is not at all proven that it is playing an essential role in the treatment. Also quite striking is the fact that the authors never publish data in the accepted ED journals but use different media to spread the news, some sounding impressive like "Proceedings of the National Academy of Sciences". I strongly suggest all of you interested in this issue to read Ulrike Schmidt's "Mandometer musings" in the European Eating Disorders Review, (2003, 11: 1-6) from which I took the following quote: "Taken at face value the Swedish RCT compares a relatively intensive broad-spectrum treatment against no treatment in young patients with a short duration of illness and relatively mild AN and bulimic patients whose symptom severity is not adequately described. So what is all the hype about?". My conclusion is clear: the hype is about business. W. Vandereycken
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Dear Dr. Vandereycken
Just wanted to say how much I appreciated reading your comments below in regards to the Mandometer. With the rise of the commodification of ED tx (and for-profit tx centers), it becomes even more critical to be able to discern the scientific validity of tx portrayed as "highly effective" (especially to the general public). As professionals, we also have an obligation to ensure this if we are to maintain the scientific integrity of the field.
With regards, Mary Gee Research Coordinator/VP Davis Y. Ja and Associates, Inc. San Francisco, CA Doctoral Student, Sociology University of California, San Francisco
---------------------------------------- [From the “proprietors” of the method (Dr Sφdersten ao) I received a copy of their reply to Schmidt’s criticism mentioned in my first piece (see above)] The reply in the EEDR* does not change the core of my judgement. What disturbs me most is the commercial attitude and the marketing of the approach. No serious clinician would advertise his treatment in the way it is done on their website (www.mandometer.us): "We offer the first clinically proven treatment that is highly effective for anorexia and bulimia. 75% of all those we treat go into remission, even those who have failed in 2-3 other treatment centers. As importantly, 90% of those in remission remain in remission in a five-year follow-up study. No other treatment has been shown to be effective in the treatment of serious eating disorders. We use no drugs, no psychotherapy, and do not blame either you or your parents for your condition. We simply work with you using our patented feedback technology to allow you to regain normal eating patterns without becoming overweight. Available in Sweden • Holland • Australia • California." I am working in the field of eating disorders since more than 30 years and I have seen several of this type of claims passing by: from the family therapist Minuchin promising 90% success to the Canadian guru Claude-Pierre offering a miracle cure. It is not only a symptom of grandiosity feelings, but also a minimization of the seriousness of these disorders and an exploitation of the despair of patients and their family members. They deserve the best treatment and not the best advertised treatment! I have looked at the patents of the treatment (United States Patent 5,817,006: Bergh, et al. - October 6, 1998 = Method and apparatus for measurement of eating speed; & United States Patent 6,485,419: Bergh, et al. - November 26, 2002 = Systems and methods for controlling physical activity during dieting). The fact they are patented does not include a scientific proof, it is just a commercial protection in a marketing strategy centered around a registered mark “Mandometer ®” . The authors are using scientific media for advertising purposes. And they did it wonderfully, starting ten years ago in the The Lancet upto their recent contribution in Psychoneuroendocrinology (November 2006), another example of a clever marketing strategy! Our field needs critical scientists and I hope one day the mandometer specialists return to this group.
Walter Vandereycken, M.D., Ph.D. Catholic University Leuven, Belgium * Bergh C. & Sodersten P. (2004). Viewpoint: Mandometer treatment of eating disorders - A reply. European Eating Disorders Review 12, 333-336.
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I'm inclined to agree with Walter's comments
regarding concerns once therapists start to apply a commercial patent on their
approach. I don't necessarily become sceptical, but am concerned about how
that may make a potentially useful approach less available to the treatment
community, both to evaluate it independently, and use it clinically.
Pharmaceutical companies have their products "advertised" so to speak, in
clinical journals all the time, but clinicians have ready access to the
product. On the other hand, we have seen (in a very well publicized case here
in Canada a few years ago) how the companies can then control (or try to do
so) the publication of data that is not flattering to their product.
Nevertheless, it is still a somewhat open process, not entirely controlled by
those companies. ------------------------------ Dear Dr. Vandereycken, I can not refrain from commenting on your response to Dr. Sodersten. It has a patronizing element I have seen from some colleagues who work at our academic institutions. Simply put it sounds like, if I don't endorse it then its not legitimate. I have been in practice over 25 years and have seen probably as much or more commercialism as you. I suggest to you to look beyond the commercialism because the current state of eating disorders treatments is not acceptable. Patients spend too much money on failed treatments, take too long to get better, if ever, useless medications are prescribed, and people, like yourself, continue to promote "talk therapy" as the only "evidenced based" option. The difference between Dr. Sodersten and the other "claims passing by" is that the Mandometer group is using published data and actually wants to see head to head comparisons with other treatments. In my opinion this would take too much time and the only thing that counts are the results we see in each individual patient. I hope you reconsider your thinking and try thinking outside the box. By the way, I do not have any financial interest in the Mandometer device (like the Mandometer company) and I do not sell books (like yourself). Kind regards, Louis Maletz, MD San Diego Mandometer Clinic Discussion to be continued…??? ννννννννννννννννννννννννν
Present State of Eating Disorder Research in Hungary - A Report on the 1st Hungarian Eating Disorder Congress; Budapest, September 22-23, 2006 There is an increasing interest in eating disorders in Hungary in the last decade. However, reports on eating disorder research were, until now, presented mainly at the annual congresses of the Hungarian Psychiatric Association – i.e., 8-10 presentations yearly among about 300. In 2005 an important step was the establishment of the Eating Disorder Working Group of the Hungarian Psychiatric Association. The aim of this group is to stimulate research work and clinical practice in this field, and to form a network of therapists dealing with eating disordered patients. In recent years increasing numbers of young colleagues (psychiatrists, child and adolescent psychiatrists and psychologists) began to investigate eating disorders, producing publications. In 2005, at the ECED Meeting in Innsbruck, eight Hungarian participants, mainly young Ph.D. students were present. The time had arrived to gather different experts, who were interested in this field. The Eating Disorder Working Group thus organized the first Hungarian Eating Disorder Congress in September 2006. It was a pleasant surprise that the number of participants was above 300, attended by paediatricians, psychologists, child psychiatrists, adult psychiatrists, dieticians and social workers – it was a truly interdisciplinary meeting. Many university students attended the congress, because the registration for them was free. They had joined clinical teams, and began to perform studies in eating disorders. The large number of young colleagues was a stimulating characteristic of the congress. Sixty presentations were submitted, more than the organizers had imagined beforehand. The two days began with very good plenary talks. The first speaker was Prof. Halmy, the president of the Hungarian Association on Studies of Obesity, who gave an overview about the different branches of obesity research, including biomedical studies and cultural background. The second presentation was given by Prof. Gόnther Rathner from Innsbruck, who is in a close scientific relation and friendship with some Hungarian colleagues, performing several studies involving Hungarian scientists. In an interesting presentation he spoke about the colonization of the body, the new cultural pressures aiming at changing one’s body - e.g., the role of plastic/cosmetic surgery in the modern era. The plenary presentations on the second day began with the talks by the authors of this report – Ferenc Tϊry summarized the present state and possible future of the different subtypes of eating disorders, with particular regard to the modern male disturbances, e.g. muscle dysmorphia. Bea Pαszthy gave a clinically oriented overview of treatment strategies and modern therapeutic studies of childhood onset eating disorders for the paediatricians, but also of relevance for the other experts present. She emphasized the somatic and psychological long-term effects of early onset anorexia nervosa. The third plenary talk was presented by another distinguished guest from abroad, Prof. Walter Vandereycken from Leuven, who has on many occasions helped Hungarian researchers. In his very stimulating presentation he analyzed the aspect of denial in eating disorders, offering useful strategies to deal with this important phenomenon. It was an excellent and pragmatic, theoretically well-elaborated summary for clinicians. There was an interesting plenary round table on the first day. The topic was the female body, as the representation of the surface of a culture, and the object of eating disorders. The moderator was a well-known lady of the media, who graduated as a psychologist, and is a leader of a campaign on natural female beauty. The participants came from different and interesting fields: a professor of psychology dealing with the psychology of eating, a professor of American culture who investigates the post-modern culture, a professor of ancient Roman culture, a professor of psychiatry and expert in psychodynamics, the Hungarian ‘icon’ of the fitness movement, a former world champion of fitness and Ph.D. student on physical culture and sports, and a famous painter. The discussion was very intensive, spirited, and thought-provoking about the cultural changes from ancient times to postmodernism - the meaning of the female body; disturbances of eating; body ideals, and the nature of beauty. The many presentations discussed different territories regarding eating disorders; from modern biological research (e.g. ghrelin) to the evaluation of psychological characteristics, cultural background, psycho-diagnostics, surgical complications (rupture of stomach), psychotherapeutic case reports and team work, the role of the Internet (e.g. anorectic subcultures) etc. It is important to stress the high quality of the presentations, and in this respect the young colleagues produced many well-conducted studies. There were two workshops - one introduced family therapy in eating disorders to the paediatricians. The second was the closing chord of the congress, the psychodynamically oriented analysis of two films about eating (“Eat, Drink, Man, Woman” – a Taiwanese film, and “Babette’s Feast”, a Danish film). The congress was an excellent occasion to strengthen collaborations, stimulate research, and offer new thoughts about therapy. The conference was held in an elegant hotel in Budapest. It is our plan to organize the congress every two years, alternating with the ECED general meetings. Ferenc Tϊry - tury@axelero.hu Bea Pαszthy President of the ED Working Group Secretary of the ED Working Group Hungarian Psychiatric Association Hungarian Psychiatric Association ννννννννννννννννννννννννννν C FLANDERS C In Flanders, the Dutch-speaking part of Belgium, a new organisation has been established for professionals interested in eating and weight disorders. The foundation, called "Eetexpert.be" is working mainly for the Flemish Government under whose auspices they are running a secondary prevention campaign focused on community health centres, general practitioners (family physicians), school health centres and dieticians. They have created a website - www.eetexpert.be - with information on different aspects of eating and weight disorders, and publish a newsletter for professionals. For more information you can contact the organisation directly by e-mail at: eetexpert.be@advalvas.be Walter Vandereycken ννννννννννννννννννννννννν C Special Book Offer C Marcel Dekker publishers are offering a 45% discount to ECED members on the recently published Clinical Handbook of Eating Disorders by Timothy Brewerton. This means that the book, normally retailing at US$175.00, is now available at $99.75 instead! To get the discount go to the following weblink http://www.crcpress.com/shopping_cart/products/product_detail.asp?sku=DK1146&parent_id=&pc and go through the process of ordering the book. Just before the point of purchase you will be asked to enter a discount code. The discount code for ECED members is: 072HDCED4. ννννννννννννννννννννννννννν C NETHERLANDS C The Kenniscentrum Eetstoornissen Nederland has a very unique library, because we have a large collection of about 1000 books and several magazines and a lot of articles. It’s especially interesting for people who can read Dutch; we collect every book that is written in Dutch including those about eating disorders and obesity. We own a large collection of novels and autobiographies, but also interesting scientific books in English and German. Further information is available from Liesbeth Libbers by e-mail: l.libbers@eetstoornis.info or website: www.eetstoornis.info ννννννννννννννννννννννννννν
C ENGLAND C Check out a very informative website (managed by Lucy Serpell) that will act as your clearing house for resources on eating disorders. It's aimed at professionals, sufferers and carers and is to be found at: www.edr.org.uk It aims to include the latest research findings in the field as well as acting as a forum for discussion. Lucy Serpell ννννννννννννννννννννννννννν C BELGIUM C A new website has been developed for a self-help group involving parents and carers in Belgium and the details can be found at www.miata.be (French) or at www.anbn.be (Dutch). Yves Simon ννννννννννννννννννννννννννν C Back in print! C Eating Disorders - a Parents' Guide (revised edition), written by Rachel Bryant-Waugh and Bryan Lask, is again available through Brunner-Routledge, Publishers. Cost £9.99 Bryan Lask
ννννννννννννννννννννννννννν C SWITZERLAND C In Switzerland, a National Group of Professionals specialized in treatment, in research or prevention of eating disorders have founded a network called Netzwerk-Esstφrungen Schweiz ENES (German Name), Reseau Expert Suisse Trouble Alimentaires RESTA (French Name) in 2002. All important information concerning ENES/RESTA are on the homepage www.netzwerk-esstoerungen.ch Erika Toman ννννννννννννννννννννννννννν The Embodied Psychotherapist: An Exploration of the Therapists' Somatic Phenomena Within the Therapeutic Encounter by Robert Shaw (Correspondence concerning this article should be addressed to Robert Shaw, 41 St. John Street, Ashbourne, Derbyshire, DE6 1GP, United Kingdom. E-mail: rest@psychost.fsnet.co.uk.) This study explores psychotherapists' somatic experiences during the therapeutic encounter, linking these to ideas from the phenomenological school of philosophy, in particular the notion of the lived-body paradigm in relation to therapists' physical reactions to clients. The methodology for this research evolved from 3 discussion groups, which led to a series of 14 in-depth interviews and 2 professional scrutiny discussion groups. All the participants were experienced psychotherapists. A grounded-theory analysis generated a set of first-order themes that were clustered into the second-order themes of body empathy, body as receiver, and body management. The final grounded theory of psychotherapist embodiment emerged after an analysis of the permeative themes of professional and personal discourse and researchers' bodily responses. The grounded theory of psychotherapist embodiment has revealed the importance of the therapist's body within the therapeutic encounter. View the full article in Psychotherapy Research 14(3) 271-288, 2004 © 2004 Society for Psychotherapy Research Walter Vandereycken ννννννννννννννννννννννννννν C ENGLAND C Are you interested in training or supervision in evidence-based treatments for eating disorders? If so, then Professor Christopher Fairburn will send you all the information you need to get involved in such training and/or supervision. Chris can be contacted directly by e-mail on: credo@medicine.ox.ac.uk Chris Fairburn ννννννννννννννννννννννννννν ST GEORGE’S HOSPITAL PLACEMENTS Professionals who would like to see any eating disorder related treatments in action can contact Hubert Lacey: hlacey@sghms.ac.uk Longer-term training placements (unfortunately unpaid) are also available in psychiatry, psychology, psychotherapy, nursing and occupational therapy. Hubert Lacey ννννννννννννννννννννννννννν C New International Journal C Body Image is a new international, peer-reviewed journal that publishes high-quality, scientific articles on body image and human physical appearance. Body Image is a multi-faceted concept that refers to persons’ perceptions and attitudes about their own body, particularly but not exclusively its appearance. The journal invites contributions from a broad range of disciplines-psychological science, other social and behavioral sciences, and medical and health sciences. The journal publishes original research articles, brief research reports, theoretical and review papers, and science-based practitioner reports of interest. Dissertation abstracts are also published online, and the journal gives an annual award for the best doctoral dissertation in this field. For further details see: http://www.elsevier.com/locate/bodyimage Walter Vandereycken
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